Nokea
The nurse notices the uterus is boggy and the bladder is full. What intervention should the nurse perform next?
- A. Call for help.
- B. Start IV bolus.
- C. Get the person out of bed to walk to restroom.
- D. Massage the fundus and assess the lochia.
Correct Answer: D
Rationale: A boggy uterus and full bladder may indicate uterine atonyand fundal massage is the first intervention to promote uterine contraction.
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What is the most common reason for late postpartum hemorrhage (PPH)?
- A. Subinvolution of the uterus
- B. Defective vascularity of the decidua
- C. Cervical lacerations
- D. Coagulation disorders
Correct Answer: A
Rationale: Late postpartum hemorrhage (PPH), defined as occurring between 24 hours and up to 12 weeks after delivery, is most commonly due to subinvolution of the uterus. This occurs when the uterus fails to return to its normal pre-pregnancy size. Subinvolution can be caused by retained products of conception, uterine infection, uterine anomalies, or inadequate contraction of the uterine muscles. When the uterus does not contract effectively, it is unable to compress the blood vessels at the site of the placental attachment, leading to persistent bleeding. Subinvolution of the uterus is an important cause of late PPH and requires prompt intervention to prevent excessive blood loss and its associated complications.
The nurse on a postpartum unit observes a patient who delivered 2 days ago. The nurse notices extreme agitation and depressed mood. The patient states, “I think that my baby is deformed inside and we have to fix him.” Which risk factor is most strongly related to possible postpartum psychosis (PPP)?
- A. Separation from the baby’s father
- B. Personal history of bipolar disorder
- C. Prolonged labor resulting in cesarean
- D. Loss of first child from a heart defect
Correct Answer: B
Rationale: The correct answer is B, personal history of bipolar disorder. Postpartum psychosis is a severe mental health condition that can occur in women with a history of bipolar disorder. Bipolar disorder is a major risk factor for developing postpartum psychosis due to the hormonal changes and stress of childbirth. The extreme agitation, depressed mood, and delusional thoughts exhibited by the patient in the scenario are indicative of postpartum psychosis.
Choice A, separation from the baby’s father, is not a strong risk factor for postpartum psychosis. Choice C, prolonged labor resulting in cesarean, is associated with physical complications but not necessarily with postpartum psychosis. Choice D, loss of the first child from a heart defect, is a traumatic event but is not directly linked to the development of postpartum psychosis.
The nurse is assisting the primary care provider with the third stage of a vaginal delivery. The patient is multiparous, experienced a precipitous birth, and has a history of hypertension. Which medical prescription does the nurse anticipate for this patient?
- A. Methylergonovine
- B. Fresh frozen plasma
- C. Carboprost-tromethamine
- D. Magnesium sulfate
Correct Answer: C
Rationale: The correct answer is C: Carboprost-tromethamine. In the given scenario, the patient is multiparous, had a precipitous birth, and has a history of hypertension. Carboprost-tromethamine is typically administered in the third stage of labor to manage postpartum hemorrhage, which is a potential complication in this case due to the patient's history of hypertension. Methylergonovine (choice A) is contraindicated in patients with hypertension due to its vasoconstrictive effects. Fresh frozen plasma (choice B) is not typically indicated for postpartum hemorrhage. Magnesium sulfate (choice D) is commonly used for pre-eclampsia/eclampsia but not specifically for postpartum hemorrhage in this scenario.
A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse 's response?
- A. The client 's obstetric status is optimal for receiving the vaccine.
- B. The client 's immune system is highly responsive during the postpartum period.
- C. The client 's baby will be high risk for acquiring rubella if the woman does not receive the vaccine.
- D. The client 's insurance company will pay for the shot if it is given during the immediate postpartum period.
Correct Answer: B
Rationale: The postpartum period offers a good opportunity for immunization because the immune system is more responsive. Administering the vaccine before discharge ensures the woman is protected in the future.
The nurse educates the person recovering from a cesarean birth on how to care for the incision. What education is discussed?
- A. Scrub the incision well twice daily.
- B. Remove the dressing the day after birth.
- C. Staples will be removed the day after birth.
- D. Vertical incisions heal faster with less pain.
Correct Answer: B
Rationale: The dressing should be removed after the first 24 hours and incision care should focus on preventing infection and ensuring proper healing.